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May 16, 2026Frontiers in Medicine0 citationsOpen Access

Analysis of the predictive value of heart rate variability analysis combined with SOFA and APACHE II scores for the 28-day mortality risk of patients in the emergency intensive care unit

ZZZhaolin ZhangHHHanlin HuangPPPengyi Pan

Key Result

The combination of heart rate variability with SOFA and APACHE II scores significantly improved the prediction of 28-day mortality risk in EICU patients, achieving an AUC of 0.831.

Key Points

  • The study aims to evaluate the predictive potential of heart rate variability combined with SOFA and APACHE II scores for mortality risk in EICU patients.
  • Retrospective study involving 115 patients from the EICU, classified into survival and death groups based on survival outcome.
  • Data collected included demographic information, SOFA score, APACHE II score, and HRV indicators, analyzed using various statistical methods.
  • ROC curve analysis evaluated the predictive performance of the HRV, SOFA, and APACHE II scores.
  • The death group had significantly higher SOFA and APACHE II scores, and lower HRV indicators compared to the survival group (p < 0.05).
  • Multivariate regression identified SDHR as an independent risk factor (OR = 3.211, p = 0.041).
  • The predictive accuracy improved significantly when combining HRV, SOFA, and APACHE II scores, with AUC at 0.831.

Study Design

Type

Cohort (n=115)

Multicenter

No

Structured PICO

Does combining heart rate variability with SOFA and APACHE II scores improve the prediction of 28-day mortality in EICU patients?

P
Population
115 patients admitted to the emergency intensive care unit (EICU)
I
Intervention
Heart rate variability (HRV) analysis combined with SOFA and APACHE II scores
C
Comparator
HRV, SOFA score, or APACHE II score alone
O
Outcome
28-day mortalityhard clinical

Combining heart rate variability with SOFA and APACHE II scores significantly improves the prediction of 28-day mortality in emergency intensive care unit patients.

Main Result

Absolute Event Rate: 0.831% vs 0.776%

p-value: p=<0.001

Limitations

  • Single-center retrospective study with a relatively limited sample size
  • Based only on short-term HRV analysis without continuous dynamic monitoring
  • Potential collinearity among variables or limited statistical power due to insufficient sample size affecting the determination of independent effects

Abstract

Objective To explore the application value of heart rate variability (HRV) combined with SOFA score and APACHE II score in predicting the 28-day mortality risk of patients in the emergency intensive care unit (EICU), and to provide a basis for early clinical risk assessment. Method A retrospective study was conducted on 115 patients admitted to the EICU of the First Affiliated Hospital of Bengbu Medical University. The patients were divided into the survival group ( n = 75) and the death group ( n = 40) based on their 28-day survival outcome. Demographic data, SOFA score, APACHE II score, and HRV-related indicators were collected. Univariate analysis, multivariate Logistic regression, Spearman correlation analysis, and receiver operating characteristic curve (ROC) analysis were used to evaluate the distribution characteristics and predictive efficacy of each indicator. Result Compared with the survival group, the death group had significantly higher age, SOFA score, and APACHE II score ( p 0.05), and significantly lower HRV indicators such as PNS index and Mean RR ( p 0.01). Spearman analysis showed that SOFA score ( r = 0.378) and APACHE II score ( r = 0.456) were significantly positively correlated with death, while PNS index ( r = −0.278) and Mean RR ( r = −0.299) were negatively correlated with death (all p 0.01). In the multivariate regression, only SDHR was an independent risk factor (OR = 3.211, p = 0.041). ROC curve analysis showed that the AUCs of HRV, SOFA score, and APACHE II score for predicting death were 0.737, 0.728, and 0.776, respectively. The AUC was 0.831 when the three were combined, indicating a significant improvement in predictive performance. Conclusion Heart rate variability parameters can reflect the autonomic nerve function status of EICU patients. The combination of HRV with the SOFA score and APACHE II score system can improve the accuracy of predicting the 28-day mortality risk of EICU patients.

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Cite This Study

Zhang et al. (2026) conducted a cohort in Critically ill patients in the emergency intensive care unit (EICU) (n=115). Heart rate variability (HRV) combined with SOFA and APACHE II scores vs. APACHE II score alone was evaluated on 28-day mortality prediction (Area Under the Curve) (95% CI 0.754-0.907, p=<0.001). The combination of heart rate variability with SOFA and APACHE II scores significantly improved the prediction of 28-day mortality risk in EICU patients, achieving an AUC of 0.831.

synapsesocial.com/papers/6a0808afa487c87a6a40af2chttps://doi.org/10.3389/fmed.2026.1832778
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